What is Ketoacidosis? Types, Symptoms, Cause & Treatment

Owing to their similar names, people sometimes confuse ketosis and ketoacidosis. Ketosis is a part of healthy metabolism and can lead to more efficient energy-production through the burning fat instead of glucose. Ketoacidosis, on the other hand, is a dangerous and potentially fatal metabolic condition, in which there are very high levels of glucose or sugar along with ketones. This condition will make blood more acidic, which is harmful to health in many ways.

Moving ahead in this article we will understand what is ketoacidosis, its types, cause, symptoms and treatment options.


What is Ketoacidosis?

Ketoacidosis, or metabolic acidosis, occurs when you ingest something that gets metabolized into an acid. It has many causes, such as (1) –

  • Kidney disease
  • Large doses of aspirin
  • Shock
  • Abnormal metabolism

While ketoacidosis itself is a condition, it has 2 major types –

  1. Diabetic ketoacidosis (DKA), which mostly develops in people with type 1 diabetes (2, 3)
  2. Alcoholic ketoacidosis, which is caused by excessive consumption of alcohol (4)

There is also a less common type of ketoacidosis, called starvation ketoacidosis, which occurs mostly in women who are pregnant in their third trimester and experience excessive vomiting (5).

The condition is temporary where you can control it by having proper meals during the third trimester. Additionally, your doctor might prescribe you medicines, so as not to worsen the insulin-resistant state.

Diabetic ketoacidosis

Ketoacidosis is a severe condition that occurs mostly in type 1 diabetic people. The condition is also called diabetic ketoacidosis (DKA). It happens when high levels of ketones start to build up in the body along with sugar.

As a result, the blood becomes too acidic, which might change the normal functioning of liver and kidney. DKA will happen if a person is already in ketosis to an extent where the body uses fat as a source of energy rather than glucose.

If there is a vast production of ketones in our body, then they will not be used up at the same rate. As a result, the acidic level of our body’s disturbed. Thus, ketones can reach dangerous levels.

DKA can occur both in people who have type 1 or type 2 diabetes. However, it’s rare in people with type 2 diabetes, since they do produce little insulin.

Diabetic ketoacidosis symptoms

Diabetic ketoacidosis can develop within 24 hours. DKA symptoms are as follows (6) –

  • Extreme thirst
  • Abdominal pain
  • A flushed face
  • Rapid breathing
  • Nausea or vomiting
  • Dry mouth and skin
  • Confusion
  • Fruity-smelling breath
  • High levels of ketones in the urine
  • Fatigue
  • High blood sugar levels
  • Frequent urination

If not treated correctly, DKA can even result in a coma or death.


A high level of ketones characterizes ketoacidosis, and it is caused when the body produces too many of them. The most common reasons for this high level of ketone production are –

Missing an insulin injection or not injecting enough insulin

If you are a diabetic patient and missing the required insulin dose, then this leaves your body with very little glucose. Ultimately, triggering diabetic ketoacidosis.

Illness or infection

Illness or infection, such as urinary tract infections, pneumonia, etc., can cause your body to produce higher levels of hormones like adrenaline or cortisol. These are hormones which counter the effect of insulin, and thus can sometimes trigger diabetic ketoacidosis.


The first thing to do when you notice symptoms of ketoacidosis is to test for ketones in a urine sample. The test can be carried out at home by placing the dip stick into the clean catch of urine.

Ketone levels in urineWhat does it suggests?
< 0.6 mmol/LNormal or low levels of ketones
> 0.6 mmol/LStarting of ketosis
= 0.6-3 mmol/LPurposeful or nutritional ketosis
> 3–5 mmol/LStarvation ketosis
> 5mmol/LHigh risk for ketoacidosis
> 10 mmol/LDKA

The dip stick will change colors based on the levels of ketones in urine. If this confirms ketosis, your doctor may ask you to undergo more tests. Some of these tests might include (7) –

  • Arterial blood gas to determine the acidity of your blood
  • A basic blood panel to assess metabolic function
  • A chest X-ray or other lab tests to look for signs of an infection, such as pneumonia
  • Blood pressure measurement


DKA treatment foremost requires a person’s abnormal blood sugar and insulin levels to be normal. This entails a combination of several approaches.

If an infection or an illness has caused DKA, your doctor will treat both your DKA and your disease, most likely with antibiotics.

If you have DKA but do not have diabetes, then your doctor will most likely create a diabetes treatment plan, so that your ketoacidosis does not recur. The different approaches are used to treat DKA. Some of them are –

1. Fluid replacement

DKA often leads to loss of fluids, and the resulting dehydration often causes higher blood sugar levels. Your doctor will try to rectify this by giving you lots of fluids. You may be given oral medication, or you may have to take in fluids intravenously through an IV.

2. Insulin therapy

You will be given Insulin until your blood sugar level reaches an acceptable range. Once this has been achieved, your doctor will provide you with recommendations as to how you can avoid the risk of DKA in the future.

3. Electrolyte replacement

If you have lower levels of insulin than you should, it can cause the levels of electrolytes in your body to become abnormally low as well. Much like fluid replacement, electrolyte levels are regulated through IV.

Alcoholic ketoacidosis

When we consume alcohol, our pancreas may stop producing insulin for a short period. This affects our body in several ways such as without the insulin, our body cannot create energy from glucose anymore, and our body temporarily resorts to burning fat to produce energy.

We already know that this is what happens when our body is in ketosis, which is not in itself harmful. But the only difference here is that there are too many ketones in the bloodstream since they cannot be burned as fast as they are produced.

This condition is similar to diabetic ketoacidosis and whatever we consume gets metabolized into an acid.


Alcoholic ketoacidosis (AKA) can develop when you consume excessive amounts of alcohol for extended periods of time. Unrestricted alcohol consumption can cause malnourishment, leaving the body without enough nutrients for it to function well.

People who consume massive quantities of alcohol may not eat food regularly, or they may vomit as a result of drinking too much. Both these things can lead to starvation, which further reduces the body’s capacity to produce insulin.

If you are already malnourished because of excessive drinking, then you are at risk of developing alcoholic ketoacidosis. This can take place as early as one day after a drinking binge, contingent upon factors such as overall health status and nutritional status, and the amount of alcohol consumed.


Two factors influence the symptoms of alcoholic ketoacidosis such as how much alcohol the person has consumed, and the number of ketones present in their bloodstream. The most common symptoms of alcoholic ketoacidosis are as follows –

  • Abdominal pain
  • Loss of appetite
  • Slow movement
  • Fatigue
  • Nausea and vomiting
  • Irregular, deep, and rapid breathing (also known as Kussmaul’s sign)
  • Agitation and confusion
  • Decreased alertness or coma
  • Symptoms of dehydration, such as thirst, lightheadedness, or vertigo

A person who develops symptoms of alcoholic ketoacidosis may also have other conditions typically associated with alcohol abuse. These include –

  • Liver disease
  • Ulcers
  • Pancreatitis
  • Ethylene glycol poisoning
  • Kidney disease

All of these conditions will have to be ruled out by a doctor before you diagnose with alcoholic ketoacidosis.


If you go to the doctor exhibiting symptoms of alcoholic ketoacidosis, your doctor will perform a thorough physical examination and will ask you about your alcohol consumption and health history.

You might also go for additional tests to ensure that any other medical conditions should not be responsible for the symptoms that you’re exhibiting. After all the test results are collated, your doctor can proceed with confirming the diagnosis.

Possible tests to diagnose alcoholic ketoacidosis include the following –

  • Blood alcohol test
  • Blood glucose test
  • Blood urea nitrogen (BUN) and creatinine tests, to determine the efficiency of your kidneys
  • Arterial blood gas test – To measure your blood’s acid/base balance and oxygen levels
  • Anion gap calculation – To measure sodium and potassium levels
  • Serum lactate test – To determine levels of lactate in the blood, since high lactate levels can be a sign of lactic acidosis
  • Amylase and lipase tests – To check for pancreatitis and monitor your pancreas
  • Blood chemistry panel (CHEM-20) – To get a detailed analysis of your metabolism
  • Urine test for ketones

Should your blood glucose levels be elevated, your doctor may also suggest a hemoglobin A1C (HgA1C) test. This test will confirm whether you have diabetes or not?

In case you do, then you will require additional treatment plan on top of your treatment for alcoholic ketoacidosis.


Alcoholic ketoacidosis is usually treated in the emergency room. Your doctor will carefully evaluate your heart rate, blood pressure, and breathing.

You may be given fluids intravenously that will also cover underlying malnutrition, most likely through various vitamins and nutrients such as –

  • Thiamine
  • Magnesium
  • Phosphorus
  • Potassium

You may also be taken to the intensive care unit (ICU) if you require prolonged care. The length of your hospital stay will then depend on the severity of the condition. It will also depend on how long it takes for your body to return to its normal state.


Ketoacidosis is different from ketosis, which is a normal metabolic process that happens within the body during intentional fasting or consumption of a low carb diet or keto diet.

On the other side, if you have type I diabetes or consume too much alcohol, you can have unusually high levels of ketones in your blood and develop ketoacidosis.

As we have seen, ketoacidosis can even be a fatal condition and sometimes develop within 24 hours. You must act promptly if you see symptoms of DKP. Also, if you are pregnant, you should consume regular meals, to avoid developing starvation ketoacidosis.


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